The significance of cytogenetic findings of erythroid colonies derived from a Ph+ ALL patient: fundamental differences between Ph+ ALL and blastic phase CML

Cytogenetic analysis was performed on colonies from erythroid burst-forming units (BFU-E) derived from bone marrow (BM) cells of a Ph-positive acute lymphocytic leukemia (Ph+ ALL) patient. A normal diploid karyotype was revealed in all 15 metaphases that could be analyzed in the erythroid colonies. Previous cytogenetic analyses of erythroid colonies obtained from BM cells of patients with Ph+ chronic myelogenous leukemia (CML) revealed that Ph-positive karyotypes were predominant in all 11 cases. Two of them were also examined in blastic phase (BP) and showed 100% Ph+ cells in BFU-E-derived colonies. The present findings suggest that the leukemic process of Ph+ ALL does not involve the erythroid series, which is in contrast to the involvement in CML. This is considered to be a fundamental difference between Ph+ ALL and the blastic phase of CML (BP CML). Clinically, cytogenetic analysis of erythroid colonies from BM cells may constitute a valuable approach for the differential diagnosis between Ph+ ALL and the BP of Ph+ CML.     

Additional clonal abnormalities in Philadelphia-positive ALL and CML demonstrate a different cytogenetic pattern at diagnosis and follow different pathways at progression

The cytogenetic patterns in addition to the Philadelphia translocation in Philadelphia-positive (Ph+) ALL and chronic myeloid leukemia (CML) is heterogenous. We investigated 154 patients with Ph+ ALL at diagnosis or at relapse and 174 patients with different phases of CML. Ph+ ALL at diagnosis demonstrated a heterogenous pattern with a high frequency of numerical and structural chromosomal aberrations. CML at diagnosis presented with rare additional chromosomal changes. In Ph+ ALL, the pathway from diagnosis to relapse was characterized by the acquisition of a higher number of chromosomal aberrations, but the pattern of frequent aberrations at relapse did not differ from that observed at diagnosis. In contrast, in CML the pathway from chronic to the advanced phases was characterized by the acquisition of new chromosomal changes and by the development of karyotype complexity. In addition, the investigation of 10 cases of lymphoid blast crisis of CML showed significant differences in the karyotype in comparison to Ph+ ALL at diagnosis. Therefore, the karyotype can be helpful in discriminate de novo lymphoid blast crisis of CML from de novo Ph+ ALL. In conclusion, we were able to demonstrate that the cytogenetic patterns of Ph+ ALL and of CML are different at diagnosis and furthermore follow different pathways during progression or relapse.     

Cytogenetic analysis of hematologic malignancies in Hong Kong. A study of 98 cases.

The karyotypes of 98 patients between the ages of 8 and 81 years with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), myelodysplastic syndromes (MDS), and chronic myeloid leukemia (CML) are presented. Although the well-described cytogenetic abnormalities associated with particular FAB subtypes in the West were observed, certain important local differences were noted. In ALL, hyperdiploidy was rarely observed, whereas the Philadelphia chromosome was observed in 50% of abnormal karyotypes. In AML, the t(8;21) was infrequently observed in M2 case, whereas trisomy 4 and 6, rarely reported elsewhere, formed 12% of the abnormal cases. In MDS, the incidence of -5/5q- and/or -7/7q- was 83% of cases with aberrant cytogenetic findings. Neither i(17q) nor an extra Ph was seen in 26 cases of CML including 9 cases of accelerated phase/blast crisis. In addition, previously unreported cytogenetic abnormalities occurring as single cases are presented. These findings are discussed in the context of geographical heterogeneity of chromosomal abnormalities in leukemia and emphasize the importance of continued epidemiologic studies of cytogenetics in hematologic malignancies.     

Combination assay of IAP and ADA in hematologic malignancies

We measured the levels of adenosine deaminase (ADA) and immunosuppressive acid protein (IAP) in 10 patients with acute myeloid leukemia (AML), 5 with acute lymphoblastic leukemia (ALL), 8 with chronic myeloid leukemia (CML), 7 with myelodysplastic syndrome (MDS), 5 with malignant lymphoma (ML), 3 with multiple myeloma (MM) and one with adult T cell leukemia. On admission, the level of IAP was abnormally high in all cases of AML and ALL 50% of CML cases, 71.4% of MDS cases, 60% of ML cases and none of MM cases. ADA was elevated in all cases of ALL, 77.8% of AML and CML cases, 57.1% of MDS cases, 60% of ML cases and 33.3% of MM cases. In 7 patients with AML, the level of IAP returned to normal when they achieved complete remission. On the other hand, the level of ADA had already returned to normal even during induction therapy. ADA showed a positive correlation with the absolute number of peripheral blasts and lactic dehydrogenase both in AML and ALL. These results suggest that ADA indicates the activity of leukemia and IAP indicates the immunocompetence of the host.     

Serum adenosine deaminase and its isozyme activity in leukemia and MDS

We studied the activity of serum adenosine deaminase (ADA) and its isozyme in 36 leukemic patients (16 ANLL, 11 ALL, and 9 CML) and 8 MDS. Isozyme was measured by erythro-9-(2-hydroxy-3-nonyl) adenine (EHNA) inhibitory assay. This assay was simple and reliable. The appearance rate of abnormally high ADA value were 81.24% for ANLL, 100% for ALL, 77.8% for CML and 37.5% for MDS. The ADA level became high when MDS turned into overt leukemia. In isozyme pattern, there was a clear difference between ANLL and ALL. The isozyme I/II ratio was significantly higher (p less than 0.001) in ALL than ANLL. Lymphoblastic crisis of CML also had a high isozyme I/II ratio. There was a correlation between isozyme I and absolute number of peripheral blasts in ALL (r = 0.768). When observed time sequentially, ADA and isozyme changed correlatively with the number of blasts counts. Serum ADA and its isozyme are useful parameters both for leukemic diagnosis and treatment.     

bcr rearrangements in Philadelphia chromosome-positive acute lymphoblastic leukemia. A study of five Chinese patients in Taiwan

Cytogenetic studies were successfully conducted on 73 Chinese patients with acute lymphoblastic leukemia (ALL). A Philadelphia chromosome (Ph) was identified in four (9%) of the 46 children and in four (15%) of the 27 adults. None of these patients had any clinical features suggestive of chronic myelogenous leukemia (CML). Leukemic cells from five of the eight Ph-positive (Ph+) ALL patients were analyzed for bcr rearrangement by Southern blot analysis with three restriction enzymes and two bcr probes. One of the three children and both adult patients studied showed bcr rearrangement. Based on the data from the literature and the present study, 58% of adult and 14% of childhood Ph+ ALL patients demonstrated bcr rearrangement. There were no significant differences in clinical or laboratory findings between the two groups of patients with or without bcr rearrangement. Patients who had Ph+ ALL but no bcr rearrangement appear to have been victims of de novo acute leukemia, but it was still difficult to determine whether patients with bcr rearrangement had acute lymphoid transformation of subclinical CML. More studies and longer follow-ups are needed for clarification.     

A study on the incidence of ABL gene deletion on derivative chromosome 9 in chronic myelogenous leukemia by interphase fluorescence in situ hybridization and its association with disease progression

Fluorescence in situ hybridization for the BCR/ABL rearrangement in 138 bone marrow specimens from 59 Philadelphia(+) (Ph(+)) chronic myelogenous leukemia (CML) patients, 35 Ph(+) acute lymphoblastic leukemia (ALL) patients, and 57 Ph(-) ALL patients was used. Sixteen (27.1%) of the 59 CML patients had deletions of the residual ABL gene on the derivative chromosome 9. During the study period, 32 of the 59 CML patients progressed to blast crisis or accelerated phase. Of these, nine patients had residual ABL gene deletions on the derivative chromosomes 9 and 23 patients had no deletions. The mean duration from first diagnosis to blast crisis or accelerated phase for the nine patients with ABL deletions was 32.8 months, and for the 23 patients without ABL deletions, it was 62.4 months (P = 0.017). The overall survival time for the 16 patients with deletions was 32.8 months, and for the 43 patients without deletions, it was 60.1 months (P = 0.164). ABL deletions were not detected among the 35 ALL patients (17 with major BCR/ABL, 18 with minor BCR/ABL), and it appears that this deletion occurs rarely or not at all in Ph(+) ALL patients, which is in contrast to the CML patients (27.1%). However, we detected two ALL cases with ABL deletion but without BCR/ABL rearrangement among 49 Ph(-) ALL and 66 Ph(-) AML patients. In conclusion, patients with ABL deletions progress to blast crisis or accelerated phase in a significantly shorter time than do those without such deletions. It is therefore suggested that the ABL deletion is an indicator of a poor prognosis in CML.     

Different characteristics identified by single nucleotide polymorphism array analysis in leukemia suggest the need for different application strategies depending on disease category

The purpose of this study was to evaluate the detection rate of chromosomal rearrangements in leukemia using single nucleotide polymorphism array (SNP‐A) in combination with metaphase cytogenetics (MC), with the aim of proposing a practical approach for clinical karyotyping applications of SNP‐A. The Genome‐Wide Human SNP Array 6.0 (Affymetrix, Santa Clara, CA) was applied in 469 patients with a variety of hematologic malignancies. Combined use of SNP‐A with MC improved the detection rate in comparison with MC alone: acute myeloid leukemia (AML) with normal karyotype (NK), 32% versus 0%; core binding factor (CBF)‐AML 40% versus 29%; myelodysplastic syndrome (MDS), 54% versus 39%; chronic myeloid leukemia (CML), 24% versus 3%; and acute lymphoblastic leukemia (ALL), 88% versus 63%. Different patterns of abnormalities (especially the type, size, and location) were noted in the leukemia subtypes. Copy neutral loss of heterozygosity lesions was detected in 23% of AML‐NK, 3% of CBF‐AML, 25% of MDS, 2% of CML, and 20% of ALL. SNP‐A also provided information on cryptic deletions and a variety of aneuploidies in ALL, while the benefit was minimal in CML. In conclusion, different patterns of abnormal lesions were presented according to the disease category, thus requiring a different approach of adopting SNP‐A‐based karyotyping among different leukemia subtypes. © 2012 Wiley Periodicals, Inc.     

HLA-DRB1基因多态性与急性淋巴细胞白血病和慢性髓性白血病易感性关联的研究

目的探讨急性淋巴细胞白血病（ALL）和慢性髓性白血病（CML）易感性与HLA-DRB1基因多态性之间的关联性,找出急性淋巴细胞白血病和慢性髓性白血病的易感基因。方法采用序列特异性引物聚合酶链反应（PCR-SSP）DNA分型技术对56例ALL患者、48例CML患者和105例健康对照进行了HLA-DRB1基因分型。结果ALL患者组与HLA-DR7基因关联,基因频率为24.1%,RR=2.56,χ     

Chromosomes and causation of human cancer and leukemia. XLII. Ph1-positive ALL: An entity within myeloproliferative disorders?

The clinical, survival, and cytogenetic features of 8 cases with Philadelphia chromosome (Ph¹)-positive acute lymphoblastic leukemia (ALL) have been presented. Based on these data, and taken in conjunction with surface marker and enzymic characteristics of the leukemic cells, it is proposed that Ph¹-positive ALL, though sharing many of the clinical and laboratory aspects of Ph¹-negative ALL, is in some cases probably a disease of the pre-B cell type, or its close lymphoid entity, with such cell probably originating from a myeloid precursor. The reversion of Ph¹-positive ALL to chronic myelocytic leukemia (CML) and the many common features it shares with the lymphoid blastic phase (BP) of CML, as well as the rare appearance of acute myeloblastic leukemia (AML) or myeloid features subsequent to complete remission (CR) of Ph¹-positive ALL, when taken together indicate that Ph¹-positive ALL is probably a disease within the myeloproliferative disorders. The cell predominating at any one moment decides the character of the disease, which may vary from ALL to CML to AML and to the BP of CML. The literature on Ph¹-positive ALL is reviewed and tabulated and the various cytogenetic, survival, and clinical features of the disease discussed and delineated. Some of the confusing elements of Ph¹-positive ALL versus the BP of CML are also discussed and the two diseases put in perspective in light of the hypothesis of the pre-B cell (or its close lymphoid entities) origin of some of these leukemias.     

Chromosomes and causation of human cancer and leukemia. XLVII. Severe hypodiploidy and chromosome conglomerations in ALL

A case of acute lymphoblastic leukemia (ALL) of the L1 type with severe hypodiploidy in the marrow cells (modal chromosome number, 36) is described. In addition, most of the metaphases contained chromosome conglomerations which consisted of varying numbers of chromosomes and appeared similar to conglomerations previously observed by us in a case of chronic myelocytic leukemia (CML) in the blastic phase (BP), where some cells contained less than 20 chromosomes. The karyotype of the ALL cells of our case was similar to those of published near-haploid ALL cases, possibly indicative of a common pathway of cytogenetic evolution.     

双色双融合与额外信号探针在BCR/ABL融合基因检测中的比较及其意义

目的 探讨DCCF(dual color dual fusion)探针与ES(extra signal)探针在BCR/ABL融合基因检测中信号表现的特点,并明确其信号特征与染色体核型的相互关系.方法 对初治65例慢性粒细胞白血病(chronic myelocytic leukemia,CML)及50例急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患者骨髓标本进行BCR/ABL的DCDF探针的荧光原位杂交(fluorescence in situ hybridization,FISH)检测,FISH阳性标本则使用ES探针再次进行荧光原位杂交进行BCR断裂点的检测,同时对其中47例CML和40例ALL进行了核型分析.结果 FISH结果示65例CML均为BCR/ABL阳性,DCDFFISH中有17例为非典型信号表现,ES-FISH有12例为非典型信号表现;50例ALL中7例BCR/ABL阳性,ES探针显示5例BCR断裂点位于m-bcr,2例位于M-bcr.核型分析CML检出Ph阳性98%(43/44),ALL检出Ph阳性22%(7/32).结论 DCDF-FISH、ES-FISH以及核型分析各有其特性.根据每种方法的特性,对实验结果进行综合分析可对遗传学特征作出更准确判断.     

Sister chromatid exchanges in leukemic patients

Sister chromatid exchange (SCE) was studied in PHA-stimulated peripheral blood lymphocytes from 36 newly diagnosed and untreated leukemic patients: 16 with acute lymphoblastic leukemia (ALL), 10 with acute nonlymphocytic leukemia (ANLL), and 10 with chronic myelocytic leukemia (CML). The metaphases analyzed show no chromosomal abnormalities. The mean SCE frequency (mean +/- SE) for each group of patients was: 6.8 +/- 0.4, 6.6 +/- 0.3, and 7.0 +/- 0.6 per mitosis, respectively, which was significantly lower than the mean SCE score for 30 controls (8.7 +/- 0.2). No differences in SCE score among ALL, ANLL, and CML and a similar SCE frequency by chromosome number and group allowed consolidation of all the cases into a single group of 36 leukemic patients (6.8 +/- 0.3). When the frequency of SCE was compared by chromosome number and group between the leukemic patients with the control group, a significant decrease in SCE frequency was observed due to a low SCE score in almost all the complements, except chromosome #1. It is suggested that the low SCE rate is related to the leukemic process itself.     

双色双融合与额外信号探针在BCR/ABL融合基因检测中的比较及其意义

目的 探讨DCCF(dual color dual fusion)探针与ES(extra signal)探针在BCR/ABL融合基因检测中信号表现的特点,并明确其信号特征与染色体核型的相互关系.方法 对初治65例慢性粒细胞白血病(chronic myelocytic leukemia,CML)及50例急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患者骨髓标本进行BCR/ABL的DCDF探针的荧光原位杂交(fluorescence in situ hybridization,FISH)检测,FISH阳性标本则使用ES探针再次进行荧光原位杂交进行BCR断裂点的检测,同时对其中47例CML和40例ALL进行了核型分析.结果 FISH结果示65例CML均为BCR/ABL阳性,DCDFFISH中有17例为非典型信号表现,ES-FISH有12例为非典型信号表现;50例ALL中7例BCR/ABL阳性,ES探针显示5例BCR断裂点位于m-bcr,2例位于M-bcr.核型分析CML检出Ph阳性98%(43/44),ALL检出Ph阳性22%(7/32).结论 DCDF-FISH、ES-FISH以及核型分析各有其特性.根据每种方法的特性,对实验结果进行综合分析可对遗传学特征作出更准确判断.

Abstract：

Objective To investigate the signal patterns of dual color dual fusion (DCDF) probe and extra signal (ES) probe in the detection of BCR/ABL fusion gene, and illustrate the relation between the fluorescence in situ hybridization (FISH) pattern and the karyotype. Methods Sixty-five cases of chronic myelocytic leukemia(CML) and 50 cases of acute lymphoblastic leukemia (ALL) were detected by FISH with DCDF probe, the BCR/ABL positive samples were detected by FISH with ES probe. Among these cases, 47 cases of CML and 40 cases of ALL perform conventional cytogenetics simultaneously. Results All 65 cases of CML were all BCR/ABL positive by FISH. 17 cases showed the atypical pattern by DCDFFISH, and 12 cases showed the atypical pattern by ES-FISH. There were 7 cases of BCR/ABL positive in 50 cases of ALL by FISH. By ES-FISH, there were 5 cases in which the break-point of BCR gene was located in m-bcr, 2 cases in which the break-point of BCR gene was located in M-bcr. Conventional cytogenetics demonstrated that 43/44(98 %) cases of CML and 7/32(22 %) cases of ALL were Ph positive.Conclusion The features of DCDF-FISH, ES-FISH and conventional eytogenetic are different from each other. According to the features of these method, it can increase the precision of the adjustment of genetic feature to analyze these results comprehensively.     

双色双融合与额外信号探针在BCR/ABL融合基因检测中的比较及其意义

目的 探讨DCCF(dual color dual fusion)探针与ES(extra signal)探针在BCR/ABL融合基因检测中信号表现的特点,并明确其信号特征与染色体核型的相互关系.方法 对初治65例慢性粒细胞白血病(chronic myelocytic leukemia,CML)及50例急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患者骨髓标本进行BCR/ABL的DCDF探针的荧光原位杂交(fluorescence in situ hybridization,FISH)检测,FISH阳性标本则使用ES探针再次进行荧光原位杂交进行BCR断裂点的检测,同时对其中47例CML和40例ALL进行了核型分析.结果 FISH结果示65例CML均为BCR/ABL阳性,DCDFFISH中有17例为非典型信号表现,ES-FISH有12例为非典型信号表现;50例ALL中7例BCR/ABL阳性,ES探针显示5例BCR断裂点位于m-bcr,2例位于M-bcr.核型分析CML检出Ph阳性98%(43/44),ALL检出Ph阳性22%(7/32).结论 DCDF-FISH、ES-FISH以及核型分析各有其特性.根据每种方法的特性,对实验结果进行综合分析可对遗传学特征作出更准确判断.     

Philadelphia chromosome negative acute lymphoblastic leukemia preceding Philadelphia positive chronic myelogenous leukemia

A patient with Philadelphia chromosome (Ph) negative acute lymphoblastic leukemia (ALL, FAB type L1) developed Ph-positive chronic myelogenous leukemia (CML) after more than 2 years in complete remission. Subsequently, Ph-positive lymphoblastic transformation occurred, which was again successfully treated. Thereafter, the CML state was interrupted twice more by blast crisis. The additional chromosomal abnormalities were atypical for Ph-positive CML. The course is interpreted as a possible example of the multistep development of CML. Blastic transformation occurring prior to the Ph chromosome has been reported in only two cases previously.     

Childhood biphenotypic leukemia: detection of mixed lymphoid and myeloid populations in bone marrow specimens

In a retrospective study, consecutive bone marrow biopsies and smears from 104 children with leukemia were analyzed for expression of lymphoid and myeloid lineage-associated features. Eighty-six cases were diagnosed as acute lymphoblastic leukemia (ALL), 14 cases as acute non-lymphocytic leukemia (ANLL), and one case as chronic myelogenous leukemia (CML). Finally, three children were classified as biphenotypic leukemia demonstrating mixed populations of lymphoid and myeloid blast cells from the onset of the disease. Thus, leukemia with a dual phenotype was assessed in 2.9% of all cases examined. The recognition of bilineage origin even by conventional methods such as morphology, cytochemistry and marker studies may be important for the selection of an effective treatment.     

Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome

BACKGROUND: BCR-ABL, a constitutively activated tyrosine kinase, is the product of the Philadelphia chromosome. This enzyme is present in virtually all cases of chronic myeloid leukemia (CML) throughout the course of the disease, and in 20 percent of cases of acute lymphoblastic leukemia (ALL). On the basis of the substantial activity of the inhibitor in patients in the chronic phase, we evaluated STI571 (formerly known as CGP 57148B), a specific inhibitor of the BCR-ABL tyrosine kinase, in patients who had CML in blast crisis and in patients with ALL who had the Ph chromosome. METHODS: In this dose-escalating pilot study, 58 patients were treated with STI571; 38 patients had a myeloid blast crisis and 20 had ALL or a lymphoid blast crisis. Treatment was given orally at daily doses ranging from 300 to 1000 mg. RESULTS: Responses occurred in 21 of 38 patients (55 percent) with a myeloid-blast-crisis phenotype; 4 of these 21 patients had a complete hematologic response. Of 20 patients with a lymphoid blast crisis or ALL, 14 (70 percent) had a response, including 4 who had complete responses. Seven patients with a myeloid blast crisis continue to receive treatment and remain in remission from 101 to 349 days after starting the treatment. All but one patient with a lymphoid blast crisis or ALL has relapsed. The most frequent adverse effects were nausea, vomiting, edema, thrombocytopenia, and neutropenia. CONCLUSIONS: The BCR-ABL tyrosine kinase inhibitor STI571 is well tolerated and has substantial activity in the blast crises of CML and in Ph-positive ALL.     

Defects of natural killer cell activity in children with untreated acute lymphocytic leukemia

Summary Natural killer (NK) activity against cells of the K-562 line was significantly depressed in 12 of 18 children (66%) with untreated acute lymphocytic leukemia (ALL). No suppression of allogeneic NK activity was observed with sera of the patients, regardless of the level of NK depression. The ability of peripheral blood lymphocytes (PBLs) to suppress allogeneic NK activity was tested in two ALL patients — one with no detectable NK activity, and one with high NK activity. No NK-suppressive activity was found with PBLs of the areactive patient; PBLs of the reactive patients exhibited some suppressive activity, but only at a particular suppressor-to-effector cell ratio. Leukemic blasts were resistant to killing by autologous NK cells stimulated by IFN, as well as to killing by allogeneic, IFN-stimulated PBLs. Leukemic blasts of an ALL patient inhibited lysis of K-562 cells in an 18-h, but not in a 4-h NK assay. The inhibition could partly be reversed by pretreatment of ALL cells with alpha interferon, suggesting that the blasts might inhibit the lysis of K-562 targets in a competitive manner. Disturbed function and/or regulation of NK cells may influence attempts at NK cell activation by lymphokines.Abbreviations ALL acute lymphocytic leukemia - AML acute myeloid leukemia - CLL chronic lymphocytic leukemia - CML chronic myeloid leukemia - IFN interferon - IL-2 interleukin-2 - LGL large granular lymphocyte - NK cell natural killer cell - PBL peripheral blood lymphocyte - Poly I:C polyinosinic-polycytidylic acid